Cases of ocular syphilis on the rise

The Los Angeles Times and the AIDS Healthcare Foundation recently have reported an upsurge in cases of ocular syphilis, particularly in gay men. More than a dozen cases have been reported on the West Coast, in places like Seattle, San Francisco and Los Angeles.

Because of this, public health officials on the West Coast are now asking medical professionals to be vigilant looking for symptoms of this sexually transmitted disease that typically is a complication of primary or secondary syphilis infections, and which left untreated could cause blindness. Certain strains of the bacterium Treponema pallidum that causes syphilis are more prone to lead to infection of the eye or the central nervous system.

"These new cases … highlight the importance of ongoing, regular checkups for sexually active individuals who feel they may be at risk, particularly men who have sex with men," said AIDS Healthcare Foundation President Michael Weinstein in a health warning in which the foundation urged for more education and better strategies to reduce syphilis cases.

According to WebMD, in the early or primary stage of the disease, symptoms usually present as small sores on the genitals or in and around the mouth. In the secondary stage, a rash usually develops on the hands and soles of the feet, but it can also appear on other parts of the body and resemble other diseases. If left untreated syphilis may progress to the heart, brain and central nervous system and could lead to death.

Here in Philadelphia, although there have been no official warnings issued, cases of ocular syphilis are also on the rise.

"We are seeing it more in Philadelphia as well. Here at Wills Eye, we have seen more than a half a dozen cases this calendar year," said Dr. Allen Ho, retina surgeon and director of retina research at Wills Eye Hospital and professor of Ophthalmology at Thomas Jefferson University School of Medicine, in a phone interview.

"There are a variety of ways syphilis, called the great mimicker, can present to an eye doctor or eye specialist," he explained.

It can present as red eye, blurring of vision, inflammation, deep pain in the eye, light sensitivity, and even sudden loss of vision if it hits the back of the eye.

Dr. Ho cautions, though, that he is not saying that if you have red eye that you have syphilis. "Certainly, only a very small percentage of those with red eye have syphilis," he said.

What is important to keep in mind is that syphilis doesn't always present in the genitals right away. According to Dr. Ho, a person can have it and not know it and then the first initial presentation of the symptoms is in the eye.

The good news is that syphilis is treatable with antibiotics and penicillin interventions. It is important to be tested, though, because if left untreated, it can travel to the brain or the heart or into the whole body.

If you think you might be at risk for sexually transmitted diseases, there are STD clinics in our area that offer free or low-cost testing and treatment.  Two good places to start are http://takecontrolphilly.org/help/ and http://saferstdtesting.com.